A novel approach to the determination of clinical decision thresholds

Our objective was to determine the test and treatment thresholds for common acute primary care conditions. We presented 200 clinicians with a series of web-based clinical vignettes, describing patients with possible influenza, acute coronary syndrome (ACS), pneumonia, deep vein thrombosis (DVT) and urinary tract infection (UTI). We randomly varied the probability of disease and asked whether the clinician wanted to rule out disease, order tests or rule in disease. By randomly varying the probability, we obtained clinical decisions across a broad range of disease probabilities that we used to create threshold curves. For influenza, the test (4.5% vs 32%, p<0.001) and treatment (55% vs 68%, p=0.11) thresholds were lower for US compared with Swiss physicians. US physicians had somewhat higher test (3.8% vs 0.7%, p=0.107) and treatment (76% vs 58%, p=0.005) thresholds for ACS than Swiss physicians. For both groups, the range between test and treatment thresholds was greater for ACS than for influenza (which is sensible, given the consequences of incorrect diagnosis). For pneumonia, US physicians had a trend towards higher test thresholds and lower treatment thresholds (48% vs 64%, p=0.076) than Swiss physicians. The DVT and UTI scenarios did not provide easily interpretable data, perhaps due to poor wording of the vignettes. We have developed a novel approach for determining decision thresholds. We found important differences in thresholds for US and Swiss physicians that may be a function of differences in healthcare systems. Our results can also guide development of clinical decision rules and guidelines.

A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.

BACKGROUND: To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications. METHODS: We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5 days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p < 0.05 was the significance threshold. RESULTS: Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240 min operative (OR) time and 300 ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of 'major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels. CONCLUSIONS: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes.

A novel approach to analysing the regimes of temporary streams in relation to their controls on the composition and structure of aquatic biota

Temporary streams are those water courses that undergo the recurrent cessation of flow or the complete drying of their channel. The structure and composition of biological communities in temporary stream reaches are strongly dependent on the temporal changes of the aquatic habitats determined by the hydrological conditions. Therefore, the structural and functional characteristics of aquatic fauna to assess the ecological quality of a temporary stream reach cannot be used without taking into account the controls imposed by the hydrological regime. This paper develops methods for analysing temporary streams' aquatic regimes, based on the definition of six aquatic states that summarize the transient sets of mesohabitats occurring on a given reach at a particular moment, depending on the hydrological conditions: Hyperrheic, Eurheic, Oligorheic, Arheic, Hyporheic and Edaphic. When the hydrological conditions lead to a change in the aquatic state, the structure and composition of the aquatic community changes according to the new set of available habitats. We used the water discharge records from gauging stations or simulations with rainfall-runoff models to infer the temporal patterns of occurrence of these states in the Aquatic States Frequency Graph we developed. The visual analysis of this graph is complemented by the development of two metrics which describe the permanence of flow and the seasonal predictability of zero flow periods. Finally, a classification of temporary streams in four aquatic regimes in terms of their influence over the development of aquatic life is updated from the existing classifications, with stream aquatic regimes defined as Permanent, Temporary-pools, Temporary-dry and Episodic. While aquatic regimes describe the long-term overall variability of the hydrological conditions of the river section and have been used for many years by hydrologists and ecologists, aquatic states describe the availability of mesohabitats in given periods that determine the presence of different biotic assemblages. This novel concept links hydrological and ecological conditions in a unique way. All these methods were implemented with data from eight temporary streams around the Mediterranean within the MIRAGE project. Their application was a precondition to assessing the ecological quality of these streams.

Bird depredation of grapes in Niagara vineyards : a novel approach to identifying spatial and temporal trends /

Although local grape growers view bird depredation as a significant economic issue, the most recent research on the problem in the Niagara Peninsula is three decades old. Peer-reviewed publications on the subject are rare, and researchers have struggled to develop bird-damage assessment techniques useful for facilitating management programmes. I used a variation of Stevenson and Virgo's (1971) visual estimation procedure to quantify spatial and temporal trends in bird damage to grapes within single vineyard plots at two locations near St. Catharines, Ontario. I present a novel approach to managing the rank-data from visual estimates, which is unprecedented in its sensitivity to spatial trends in bird damage. I also review its valid use in comparative statistical analysis. Spatial trends in 3 out of 4 study plots confirmed a priori predictions about localisation in bird damage based on optimal foraging from a central location (staging area). Damage to grape clusters was: (1) greater near the edges of vineyard plots and decreased with distance towards the center, (2) greater in areas adjacent to staging areas for birds, and (3) vertically stratified, with upper-tier clusters sustaining more damage than lower-tier clusters. From a management perspective, this predictive approach provides vineyard owners with the ability to identify the portions of plots likely to be most susceptible to bird damage, and thus the opportunity to focus deterrent measures in these areas. Other management considerations at Henry of Pelham were: (1) wind damage to ice-wine Riesling and Vidal was much higher than bird damage, (2) plastic netting with narrow mesh provided more effective protection agsiinst birds than nylon netting with wider mesh, and (3) no trends in relative susceptibility of varietals by colour (red vs green) were evident.

A novel approach to processing high-performance polymers that exploits entropically driven ring-opening polymerization

Blends of the poly(ether sulfone) derived from 4,4'-biphenol and 4,4'-dichlorodiphenylsulfone (Radel-R(TM)) with its homologous macrocyclic oligomers show greatly lowered melt viscosities relative to that of the parent polymer, potentially enabling more facile production and fabrication of fiber-reinforced composite materials. The macrocycles can then undergo entropically driven ring-opening polymerization in situ. The required blends can be obtained easily in one step, by carrying out polycondensations at concentrations lower than those usually used for polymer synthesis.

A novel approach to the detection of synchronisation in EEG based on empirical mode decomposition

Transient neural assemblies mediated by synchrony in particular frequency ranges are thought to underlie cognition. We propose a new approach to their detection, using empirical mode decomposition (EMD), a data-driven approach removing the need for arbitrary bandpass filter cut-offs. Phase locking is sought between modes. We explore the features of EMD, including making a quantitative assessment of its ability to preserve phase content of signals, and proceed to develop a statistical framework with which to assess synchrony episodes. Furthermore, we propose a new approach to ensure signal decomposition using EMD. We adapt the Hilbert spectrum to a time-frequency representation of phase locking and are able to locate synchrony successfully in time and frequency between synthetic signals reminiscent of EEG. We compare our approach, which we call EMD phase locking analysis (EMDPL) with existing methods and show it to offer improved time-frequency localisation of synchrony.

A novel approach to national technological accumulation and absorptive capacity: aggregating Cohen and Levinthal

The paper develops a more precise specification and understanding of the process of national-level knowledge accumulation and absorptive capabilities by applying the reasoning and evidence from the firm-level analysis pioneered by Cohen and Levinthal (1989, 1990). In doing so, we acknowledge that significant cross-border effects due to the role of both inward and outward FDI exist and that assimilation of foreign knowledge is not only confined to catching-up economies but is also carried out by countries at the frontier-sharing phase. We postulate a non-linear relationship between national absorptive capacity and the technological gap, due to the effects of the cumulative nature of the learning process and the increase in complexity of external knowledge as the country approaches the technological frontier. We argue that national absorptive capacity and the accumulation of knowledge stock are simultaneously determined. This implies that different phases of technological development require different strategies. During the catching-up phase, knowledge accumulation occurs predominately through the absorption of trade and/or inward FDI-related R&D spillovers. At the pre-frontier-sharing phase onwards, increases in the knowledge base occur largely through independent knowledge creation and actively accessing foreign-located technological spillovers, inter alia through outward FDI-related R&D, joint ventures and strategic alliances.

Taxonomic free sorting: a successful method with older consumers and a novel approach to preference mapping

Taxonomic free sorting (TFS) is a fast, reliable and new technique in sensory science. The method extends the typical free sorting task where stimuli are grouped according to similarities, by asking respondents to combine their groups two at a time to produce a hierarchy. Previously, TFS has been used for the visual assessment of packaging whereas this study extends the range of potential uses of the technique to incorporate full sensory analysis by the target consumer, which, when combined with hedonic liking scores, was used to generate a novel preference map. Furthermore, to fully evaluate the efficacy of using the sorting method, the technique was evaluated with a healthy older adult consumer group. Participants sorted eight products into groups and described their reason at each stage as they combined those groups, producing a consumer-specific vocabulary. This vocabulary was combined with hedonic data from a separate group of older adults, to give the external preference map. Taxonomic sorting is a simple, fast and effective method for use with older adults, and its combination with liking data can yield a preference map constructed entirely from target consumer data.

A novel approach to robust parameter estimation using neurofuzzy systems

A novel approach for solving robust parameter estimation problems is presented for processes with unknown-but-bounded errors and uncertainties. An artificial neural network is developed to calculate a membership set for model parameters. Techniques of fuzzy logic control lead the network to its equilibrium points. Simulated examples are presented as an illustration of the proposed technique. The result represent a significant improvement over previously proposed methods. (C) 1999 IMACS/Elsevier B.V. B.V. All rights reserved.

Artificial neural networks: A novel approach to analysing the nutritional ecology of a blowfly species, Chrysomya megacephala

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Light-emitting diode effects on combined decellularization of tracheae. A novel approach to obtain biological scaffolds

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Transoral Submucosal Resection of the Inferior Turbinate A Novel Approach to Functional Rhinoplasty

Background: In the presence of turbinate dysfunction, an inferior turbinectomy for persistent hypertrophy of bone and/or mucosa may be performed. We sought to explore anatomic feasibility of a transoral turbinectomy. Methods: After transoral inferior turbinectomy in 12 cadavers, average distances from the external nasal valve to inferior turbinate and from pyriform aperture to inferior turbinate were compared. Average "area of access" was calculated. Preoperative and postoperative nasal length, tip projection, and alar-base width were also compared. Results: Average distance from external nasal valve to inferior turbinate was 32.4 mm. Average distance from aperture to inferior turbinate was 2.4 mm (P < 0.0001). Average "areas of access" to nasal vault through the external nasal valve and mouth were 183.9 mm(2) and 243.6 mm(2) (P = 0.07), respectively. Conclusions: The transoral approach provides a larger "area of access" to the turbinate, a statistically significant reduction of distance to target, no postoperative changes in nasal soft tissue, and easier instrumentation.